Physical activity and risks of recurrence and progression among patients with non‐muscle invasive bladder cancer

Previous studies in solid tumors link high physical activity (PA) levels to lower cancer recurrence risk, but evidence is lacking for patients with non-muscle invasive bladder cancer (NMIBC). We evaluated the association between (changes in) PA (total, moderate-to-vigorous PA, leisure-time PA, and Dutch PA guideline adherence) and risks of NMIBC recurrence and progression. Patients diagnosed between 2014 and 2021 were recruited for the multi-center prospective cohort UroLife. Participants reported prediagnosis PA at 6 weeks (n = 1414) and postdiagnosis PA at 3 and 15 months after diagnosis (n = 1275). Multivariable proportional hazards models were used to assess the association of PA levels with risk of first and multiple recurrence(s) and progression. During a median total follow-up time of 4.6 years, 501 patients had ≥1 recurrence, 144 had ≥2 recurrences, and 157 had progression. Higher pre- and postdiagnosis PA levels were not significantly associated with risks of first recurrence, multiple recurrences, and progression. Pre-to-postdiagnosis increases of 10 metabolic equivalent of task hour/week in leisure-time PA, equivalent to 3-4 h/week of walking or 1 h/week of running, were significantly associated with lower progression risk (hazard ratio at 3 months: 0.94, 95% confidence interval: 0.89-0.99). The self-reported and relatively high PA levels could have limited the detection of associations. In conclusion, higher PA levels before or after NMIBC diagnosis were not significantly associated with lower recurrence or progression risk. Although pre-to-postdiagnosis increases in leisure-time PA were associated with lower progression risk, further research is necessary before specific PA recommendations can be formulated for patients with NMIBC.